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11
Shaw Bronner, P.T., Ph.D., O.C.S., Director, ADAM Center and Associate
Professor, Dept. of Physical erapy, Movement and Rehabilitation Sciences,
Northeastern University, Boston, Massachusetts; and Director, Physical erapy
Services, Alvin Ailey American Dance eater, New York, New York. Emma
Codman, ADAM Center, Department of Physical erapy, Movement and
Rehabilitation Sciences, Northeastern University, Boston, Massachusetts. Dana
Hash-Campbell, M.F.A., Chair, Dept. of Performing Arts, Long Island University,
Brooklyn, New York. Sheyi Ojofeitimi, D.P.T., C.F.M.T., O.C.S., Senior Research
Associate, ADAM Center; Senior Physical erapist, Alvin Ailey American Dance
eater, New York, New York; Synthesis Physical erapy, Brooklyn, New York.
Correspondence: Shaw Bronner, P.T., Ph.D., O.C.S., ADAM Center, 308B
Robinson Hall, Northeastern University, 360 Huntington Avenue, Boston,
Massachusetts 021150; shaw.bronner@gmail.com.
Copyright © 2016 J. Michael Ryan Publishing, Inc.
hp://dx.doi.org/10.12678/1089-313X.20.1.11
Abstract
The aerobic demands of today’s dance
repertoire warrant understanding of the
current cardiorespiratory tness of dancers.
e purpose of this study was to compare
aerobic tness levels of professional and
pre-professional modern dancers and de-
termine change over time. A retrospective
analysis of four groups, two professional,
and two pre-professional, was conducted in
preseason annual screens, occurring before
the professional dancers’ rehearsal period
and the students’ academic training. Rest-
ing (HRrest), peak (HRpeak), and recovery
(HRrecov) heart rate, and blood pressure
(BP) were compared in 577 dancers, using
an accelerated 3-minute step test. Smoking,
asthma, and aerobic and cross training rates
between groups were also compared. A 4
(group) X 2 (gender) MANOVA design
determined dierences between groups
and genders in all dependent variables
(p < 0.05). Using a repeated measures
ANOVA design, we compared a subgroup
over 3 years and one pre-professional
group over 4 years. ere were dierences
between groups in systolic BP and all HR
variables (p < 0.001). Professional dancers
reected better cardiorespiratory tness
than pre-professional dancers. ere were
dierences between groups in aerobic and
cross training activities but no dierences
in smoking incidence or asthma rates.
Pre-professional dancers demonstrated
improvement in aerobic tness over time
(p = 0.006) while professionals did not
change. Professional dancers display bet-
ter aerobic tness, which may reect their
performance demands. Wellness programs
appear to enhance tness in pre-profession-
al dance students over time. Additional
aerobic training is recommended for pre-
professional modern dance students to
prepare them for the performance demands
of a professional career.
Many professional dance
companies in the USA
have adopted the common
post-hire preseason screening program
developed by the Medical Taskforce
of Dance/USA.1 e main purpose
of the dance screen is to identify
potential health problems and areas
of concern, with the goal of address-
ing those issues prior to beginning a
season of technique classes, rehearsals,
and performances.
Preparticipation physical examina-
tions are mandatory for all collegiate
student-athletes in the USA.2 Increas-
ingly, pre-professional dance training
programs are adopting preseason
screens to assess incoming students’
health status.3-6 Results from dancer
screenings are often incorporated into
wellness programs within the dance
curriculum7-9 or as part of company
healthcare.10 Increased awareness of
tness, participation in injury preven-
tion and cross training programs, and
aerobic and technical11 demands of to-
day’s repertoire on all dancers empha-
size the importance of understanding
the current cardiorespiratory tness
of these individuals. e relationship
between fatigue and dance injury12-14
suggests that aerobic tness training
to reduce fatigue is warranted. Al-
though recent research in the UK has
focused on tness in the contempo-
rary dancer,15-20 it is currently unclear
whether contemporary dance and
modern dance are interchangeable
or have diering training and perfor-
mance requirements. Currently, data
on the cardiorespiratory tness levels
of professional and pre-professional
modern dancers are limited.
Two modern dance based pre-
professional university programs and
two modern dance companies have
Dierences in Preseason Aerobic Fitness
Screening in Professional and Pre-Professional
Modern Dancers
Shaw Bronner, P.T., Ph.D., O.C.S., Emma Codman, Dana Hash-Campbell, M.F.A., and
Sheyi Ojofeitimi, D.P.T., C.F.M.T., O.C.S.
Proofs to: shaw.bronner@gmail.com
12
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
used a common demographic intake
and preseason screen for over 10 years.
e two companies and one of the
university programs are housed within
one organization. All four groups
undergo common technique training
that includes Horton, Graham, ballet,
African, and other dance forms. When
comparing dancers of dierent training
levels, the investigators asked whether
pre-professional dancers are undergo-
ing adequate aerobic training to meet
the demands of a professional career.
e purposes of this study were to:
1. investigate dierences in aerobic
tness parameters, such as peak and
recovery heart rate (HR), between
groups and genders using an acceler-
ated 3-min step test; and 2. investigate
the effects of training variables on
dancers’ aerobic tness over time in
repeated annual screenings. Aerobic t-
ness was dened using several variables,
including resting HR (HRrest), peak
heart rate (HRpeak), heart rate recovery
(HRrecov), and tness rating as dened
by the accelerated 3-min step test.21,22
Methods
Data for this study were compiled
from preseason annual screens oc-
curring each year at the beginning
of the professional dancers’ rehearsal
period or students’ academic training.
The screens were conducted from
1998 to 2012, either as 1. part of the
larger 30-min post-hire Dance/USA
screen for professional dancers,21 or
2. part of the incoming 60-min dance
screening for pre-professional students
enrolled in one of two Bachelor of
Fine Arts (BFA) university programs.
A priori calculations for four groups,
with a power of 95% and α = 0.05,
determined a total sample size of 372
dancers. e majority of participants
were only screened one time. A subset
of that group was re-screened in sub-
sequent years, aording a snapshot of
change over time.
e screen consisted of a demo-
graphic and medical history question-
naire, followed by physical assessment.
e screens were conducted at the
rehearsal studios of the companies
and schools and were administered
by healthcare professionals, mostly
physical therapists involved in the
creation of the standardized screen
and its guidelines. ese same trained
individuals administered the assess-
ments from year to year.
Participants were either employed
by their dance company (Prof-Sr and
Prof-Jr) or enrolled in their respective
BFA program (BFA-1 and BFA-2) and
participated voluntarily in the study.
Screening of the Prof-Sr company,
comprised of 30 dancers, was initi-
ated in 2006 with the development of
the Dance/USA Task Force screening
project. All dancers were screened that
rst year. A subset of those dancers
was re-screened in consecutive years
(N = 15). Generally, due to time
constraints and touring schedule, only
newly hired dancers were screened in
the Prof-Sr company. erefore, in
any given year, out of 30 company
dancers, one to ve new dancers were
screened. In the Prof-Jr company, all
12 dancers were screened each year. As
this is a training company, there is a
turnover of approximately 50% each
year. In exceptional circumstances, a
dancer stayed a third year and was re-
screened that year as well. e number
of incoming freshmen in the BFA
programs uctuated from year to year,
ranging from 19 to 34 in BFA-1 and
8 to15 in BFA-2. Dancers in BFA-1
were generally not re-screened annu-
ally unless they specically requested
it. e BFA-1 dancers that were re-
screened were included in the repeated
measures analysis of screening at three
time points (N = 13). Dancers at the
BFA-2 school, because it is a small
program, were re-screened annually
throughout their 4 years (N = 38). For
professional dancers, all screens were
completed in a single session during
the rehearsal period at the start of the
company’s contract year. For incom-
ing students, all screens were com-
pleted in a single session at the onset
of the fall semester. Each participant
gave written informed consent and the
Institutional Review Board for Hu-
man Ethics granted ethical approval
for this study.
Experimental Protocol
Aerobic tness was tested using an
accelerated 3-min step test.21,22 e ac-
celerated step test was previously vali-
dated against an incremental treadmill
test comparing HRpeak, HRrecov, max-
imal VO2, (VO2 max), and recovery
VO2 (VO2 recov).22 HR was measured
using Polar USA (Warminster, PA)
HR monitors secured to each dancer’s
chest, with a receiver-watch worn
on the wrist. Dancers wore running
shoes and sat quietly for 5-min before
HRrest and blood pressure (BP) were
recorded. Participants were tested us-
ing a 0.305 m (12”) step for 3-min at
a rate of 112 steps·min-1, maintained
by a metronome. The metronome
was started prior to the test to allow
the dancers to familiarize themselves
with the tempo. ey were instructed
to step “up, up, down, down” to the
beat of the metronome. HRpeak was
recorded at 3-min. Dancers were
seated immediately after completing
the test, and HRrecov was recorded
at 1-min following completion of
the step test. After removing their
footwear, each dancer’s height (m)
was measured using a wall-mounted
rigid tape measure, and mass (kg) was
measured with a digital scale (Omron
Scale HBF-300, Omron Healthcare
Inc., Lake Forest, IL).
BMI was calculated from each
dancer’s height and mass. Each dancer
was assigned a tness rating based on
gender, age, and HRrecov step test
results, according to YMCA step test
guidelines.23,24 Previous validation of
the accelerated step test in dancers
found correlation of tness rating to
HRrecov was very high (r = 0.98).22
Because male and female HRrecov can
dier by age and gender, the tness
ratings dierentiate these variables
by gender. Fitness ratings, as dened
by the YMCA and ACSM,23,24 were
applied to the accelerated step-test
results as currently used in the Dance/
USA Post-hire Health Screen for Pro-
fessional Dancers25 and by a number
of collegiate pre-professional dance
programs throughout the USA. e
seven-category rating is 0 = Excellent,
1 = Good, 2 = Above Average, 3 =
Average, 4 = Below Average, 5 = Poor,
6 = Very Poor.
Data Analysis
Demographic information regarding
age, height, mass, years of dance train-
13
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
ing, years as a professional dancer, and
whether the individual had a history
of asthma, smoking, or participated in
supplemental cross training or aerobic
training was entered into a database in
Excel. Cross training was dened as all
non-dance and non-aerobic activities
such as strength training, stretching,
Pilates, Gyrotonics, yoga, etc. Aerobic
training was dened as activities such
as biking, swimming, running, ellipti-
cal walker, speed walking, stair master,
etc. e number of positive answers to
smoking, asthma, cross training, and
aerobic training was calculated as a
percentage of total answers. For aerobic
and cross training, participants were
asked to give examples in each category
to determine whether they understood
the question, as well as number of
hours and frequency of training each
week, to validate that they met our
criteria for a positive answer.
Comparisons were made between
the two professional and two pre-pro-
fessional groups, with respect to age,
height, and mass, using a 4 (group)
X 2 (gender) MANOVA for the three
dependent variables in SPSS (21.0,
IBM Corp, Armonk, NY). A second
4 X 2 MANOVA examined years of
dance training and BP (systolic and
diastolic). A third 4 X 2 MANOVA
evaluated the outcome variables,
HRrest, HRpeak, HRrecov, and tness
rating. Each dependent variable was
checked for outliers using Mahala-
nobis distance values. ose outliers
exceeding the cut o determined by
Χ2 table were eliminated (N = 3).
Multivariate variables were checked
for linearity, multi-collinearity, and
homogeneity of variance and covari-
ance (Box’s M test), and for individual
variables, Levene’s test was applied. As
several assumptions were violated, Pil-
lai’s trace was used for unequal sample
size. With a selected signicance of
p < 0.05, an adjusted significance
value and condence intervals were
calculated using Bonferroni correc-
tions (p < 0.0167 and 0.0125 for
three and four dependent variables,
respectively). Post hoc analyses were
conducted using Schee’s tests for
unequal sample size.
Asthmatic and smoking status and
aerobic and cross training were coded
for presence or absence. Again, they
were tested for assumptions of nor-
mality. As several assumptions were
violated, adjustments were made as
listed above, with a corrected signi-
cance value of p < 0.025.
Pearson product moment and
Spearman’s rho correlations were used
to determine whether there was a
relationship between dancers’ HRrest,
HRpeak, tness rating, BMI, age, BP,
and HRrecov.
For those dancers who were re-
screened over several years, a repeated
measures ANOVA for Group X Time
was conducted to ascertain any chang-
es in cardiorespiratory parameters, p
< 0.05. Mauchly’s test was examined
for violations of sphericity. In the case
of signicance, the Huynh-Feldt cor-
rection was applied to the degrees of
freedom (DOF) and F-value. ere
were no cases of sphericity. e analy-
sis of 3 years included all four groups,
and the analysis of 4 years examined
BFA-2 only. Pairwise comparisons
were conducted where there was a
signicant main eect.
Results
Demographic Characteristics
Data were collected from 577danc-
ers (452 female, 125 male) out of a
potential 584 dancers (99%) in the
four groups (Table 1). is included
98 professional and 479 pre-profes-
sional dancers. ose who did not
participate were injured or unavailable
during the screening period. Profes-
sional companies had an equal ratio
of male to female dancers, while pre-
professional programs had a greater
number of females compared to males.
Participants represented a diversity of
ethnic backgrounds, including 44%
African-American, 40% Caucasian,
9% Hispanics, 4% Asian, and less
than 1% Native American, African,
Middle Eastern, and Caribbean.
Professional dancers spent 7.5 hrs/
wk in technique class. e remainder
of their time was spent either in re-
hearsal or performance (30 hrs/wk).
In contrast, pre-professional dancers
spent 21 (BFA-1) and 16.5 (BFA-2)
hrs/wk, respectively, in technique
classes. Both pre-professional semes-
ters culminated in two performances
at the end of the fall and spring, with
approximately 3.0 to 6.0 hrs/wk of
rehearsal.
There were differences between
groups in age (p < 0.001) but not
gender. Post hoc analysis revealed
Prof-Sr dancers were older than Prof-
Jr dancers, followed by BFA-2 and
BFA-1 (p ≤ 0.009). ere were no
dierences between groups in height
or mass, but there were dierences
between genders, with males greater
than females for height (p < 0.001)
and mass (p < 0.001).
There were differences between
groups in years of dance training (p <
0.001). Prof-Sr dancers had a greater
number of years of dance training than
Prof-Jr dancers, BFA-1, and BFA-2 (p
< 0.001); Prof-Jr had more dance
training than BFA-2 (p = 0.014).
ere were no dierences in years of
training between the pre-professional
groups, BFA-1 and BFA-2. ere were
also dierences between genders in
years of dance training: females greater
than males (p < 0.001).
Of the dancers who answered the
relevant questions, there were no dif-
ferences in smoking (9%) or asthma
rates (14%) between groups or gen-
ders (Table 2). Forty-three percent
of dancers said that they performed
cross training activities regularly (1
to 4 times per week for the past year),
with no dierences between groups or
genders. irty-six percent of dancers
said they performed aerobic training.
ere were dierences between groups
in aerobic training (p = 0.014) but no
dierences between genders. Post hoc
analysis found no dierences.
Mean BP was 114/71 mm Hg
(Table 3). ere was a dierence be-
tween groups and genders in systolic
BP (p < 0.001) but not in diastolic
BP. Females systolic BPs were lower
than males. Post hoc, Prof-Sr, and
Prof-Jr dancers systolic BPs were lower
than BFA-1 (p ≤ 0.002). ere were
also dierences between groups in
HRrest (p < 0.001). Post hoc, Prof-Sr,
and Prof-Jr dancers mean HRrest was
lower than that of BFA-1 and BFA-2
dancers (p < 0.001), and BFA-1 was
lower than BFA-2 (p < 0.001). ere
were no dierences between genders
in HRrest.
14
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
Aerobic Fitness
Mean HRpeak was 150 ± 18 beats·min-1
(range 99 to 201 beats·min-1), with
differences between groups (p <
0.001). Post hoc, Prof-Sr, and Prof-Jr
dancers HRpeak was lower than that
of BFA-1 and BFA-2 (p < 0.001),
and BFA-1 was lower than BFA-2 (p
= 0.004). ere was also a gender dif-
ference, with HRpeak lower in males
compared to females (p < 0.001).
HRrecov followed a similar pattern,
with dierences between groups (p <
0.001). Post hoc, Prof-Sr, and Prof-Jr
dancers mean HRrecov was lower than
that of BFA-1 and BFA-2 (p < 0.001),
and BFA-1 was lower than BFA-2 (p =
0.004). is pattern was also reected
in the dierences between groups in
tness ratings (p < 0.001). Post hoc,
Prof-Sr, and Prof-Jr dancers tness rat-
ings (more t) exceeded those of BFA-
1 and BFA-2 dancers (p < 0.001), and
BFA-1 tness ratings exceeded those
of BFA-2 (p < 0.001). ere were no
dierences between genders in HRre-
cov or tness ratings.
Table 2 Group Demographics: Part II
Group Gender Smoking Asthma Cross
Training Aerobic (%)*
Prof-Sr Female 2 (10%) 6 (30%) 7 (70%) 5 (56%)
Male 5 (29%) 3 (18%) 6 (60%) 6 (60%)
Total 7 (19%) 9 (24%) 13 (67%) 12 (60%)
Prof-Jr Female 2 ( 7%) 7 (23%) 7 (50%) 5 (36%)
Male 4 (13%) 3 (10%) 8 (53%) 4 (27%)
Total 6 (10%) 10 (17%) 15 (50%) 9 (30%)
BFA-1 Female 25 (8%) 41 (12%) 134 (42%) 115 (36%)
Male 3 (4%) 13 (19%) 20 (32%) 14 (22%)
Total 28 (7%) 54 (13%) 154 (40%) 129 (34%)
BFA-2 Female 10 (15%) 5 ( 7%) 28 (42%) 25 (37%)
Male 1 (11%) 4 (44%) 5 (50%) 5 (56%)
Total 11 (14%) 9 (13%) 33 (44%) 30 (39%)
Total Female 39 ( 9%) 59 (13%) 176 (43%) 150 (37%)
Male 13 (10%) 23 (18%) 39 (40%) 29 (30%)
Total 52 ( 9%) 82 (14%) 217 (43%) 179 (36%)
*ere were dierences between groups in aerobic training [F(3,514) = 3.588, p = 0.014].
Abbreviations: Number of positive responses out of total, % smoking, % asthma, % cross
training, and % aerobic training, aerobic; Prof-Sr; junior professional company, Prof-Jr;
Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2.
Table 1 Group Demographics: Part 1
Group Gender Age (years)* Height (m)† Mass (kg)§ BMI ‡Training
(years)|| Prof (years)
Prof-Sr 20 F 27.35 ± 3.83 1.66 ± 0.06 55.08 ± 3.52 19.98 ± 1.36 19.85 ± 6.11 7.35 ± 3.69
18 M 26.67 ± 3.48 1.80 ± 0.06 75.48 ± 5.14 23.27 ± 1.33 14.44 ± 4.06 8.39 ± .05
38 Total 27.03 ± 3.64 1.73 ± 0.09 64.75 ± 11.18 21.54 ± 2.13 17.29 ± 5.85 7.84 ± 3.85
Prof-Jr 30 F 21.17 ± 1.56 1.65 ± 0.05 54.39 ± 5.19 19.97 ± 1.43 13.83 ± 5.11 1.07 ± 0.98
30 M 21.63 ±1.79 1.77 ± 0.07 70.46 ± 8.67 22.37 ± 2.20 10.73 ± 3.42 0.93 ± 0.78
60 Total 21.40 ± 1.68 1.71 ± 0.09 62.43 ± 10.76 21.17 ± 2.13 12.28 ± 4.58 1.00 ± 0.88
BFA-1 333 F 18.02 ± 0.85 1.65 ± 0.08 56.09 ± 5.58 20.68 ± 1.99 11.72 ± 3.38 0 ± 0
65 M 18.33 ± 1.00 1.76 ± 0.05 68.82 ± 6.27 22.16 ± 2.20 7.10 ± 4.11 0 ± 0
401 Total 18.07 ± 0.87 1.67 ± 0.08 58.33 ± 7.49 21.43 ± 1.99 10.91 ± 3.93 0 ± 0
BFA-2 69 F 19.16 ± 3.12 1.62 ± 0.06 58.65 ± 8.58 22.27 ± 2.49 10.62 ± 4.80 0 ± 0
9 M 19.22 ± 1.20 1.77 ± 0.06 67.48 ± 7.11 21.62 ± 1.91 5.89 ± 5.21 0 ± 0
78 Total 19.17 ± 2.96 1.64 ± 0.08 59.67 ± 8.85 22.20 ± 2.43 10.07 ± 5.04 0 ± 0
Total 452 F 18.82 ± 2.62 1.64 ± 0.07 56.35 ± 6.12 20.85 ± 2.10 12.06 ± 4.30 0.39 ±1 .72
125 M 20.35 ± 3.39 1.77 ± 0.06 70.06 ± 7.15 22.33 ± 1.73 8.91 ± 4.85 1.41 ± 3.26
577 All 19.17 ± 2.88 1.67 ± 0.09 59.37 ± 8.52 21.17 ± 2.11 11.36 ± 4.61 0.62 ± 2.19
Abbreviations: years, years; body mass index, BMI; training, dance training; professional experience, prof; senior professional company, Prof-Sr;
junior professional company, Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2; female, F; male,
M. *Dierences between groups in age [F(3,569) = 319.6527, p < 0.001]. Post hoc Prof-Sr versus Prof-Jr, BFA-1, BFA-2, p < 0.001; Prof-Jr
versus BFA-1, BFA-2, p < 0.001; BFA-1 versus BFA-2, p = 0.009. Gender: no dierences. †Dierences between genders in height [F(1,569 =
177.303, p < 0.001)]. ‡Dierences between genders in mass [F(1,569 = 275.7028, p < 0.001)]. ||Dierences between groups in years of dance
training [F(3,566) = 49.382, p < 0.001]. Post hoc Prof-Sr versus Prof-Jr, BFA-1, and BFA-2, p < 0.001; Post hoc Prof-Jr versus BFA-2, p = 0.014.
Dierences between genders in years of dance training [F(1,566) = 65.279, p < 0.001].
[Author: Table 1 in “Mass (kg)” column there is a “§” however there is no
corresponding footnote for that symbol. Should it be deleted?]
15
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
Resting HR was strongly correlated
to HRrecov (r = 0.61, p < 0.001), t-
ness rating (r = 0.58, p < 0.001), and
HRpeak (r = 0.70, p < 0.001). HRpeak
was highly correlated to HRrecov (r =
0.70, p < 0.001) and tness rating (p
= 0.62, p < 0.001), and HRrecov was
highly correlated to tness rating (r =
0.94, p < 0.001). Age demonstrated a
weak negative correlation to HRrecov
(r = -0.220, p < 0.001), but there was
no relationship between BMI or BP
and HRrecov.
Changes Over Time
Seventy-two dancers from the four
groups were screened over 3 years
(Table 4). ere were changes in sys-
tolic BP between groups (p = 0.001).
Systolic BP in Prof-Sr was lower than
that of BFA-1 and BFA-2 dancers
(post hoc Prof-Sr versus BFA-1, p
= 0.017, Prof-Sr versus BFA-2, p <
0.001). ere were dierences across
the 3 years (p = 0.044; pairwise
comparisons year 1 versus year 2, p
= 0.004, and year 1 versus year 3, p
= 0.044), with systolic BP lowering
over the 4 years, and a group-by-time
interaction (p = 0.002). ere were no
dierences between groups in diastolic
BP, but there were dierences due to
time (p = 0.005; pairwise comparisons
year 1 versus year 2, p = 0.003; year 2
versus year 3, p = 0.028).
ere were dierences due to group
in HRrest (p < 0.001; pairwise com-
parisons BFA-2 dancers versus Prof-Sr
and Prof-Jr, p ≤ 0.007) and HRpeak (p
< 0.001; pairwise comparisons BFA-2
dancers versus Prof-Sr and Prof-Jr, p
≤ 0.012), but not time. ere were
dierences in HRrecov between groups
(p < 0.001, pairwise comparisons
Prof-Sr, Prof-Jr, BFA-1 vs. BFA-2, p <
0.001), and time (p = 0.023), with an
interaction between time and group (p
= 0.006). HRrecov in BFA-2 dancers
improved over time, declining over
the 3 years (pairwise comparisons
BFA-2 dancers versus other groups p
< 0.001). Dierences in tness ratings
were also found between groups (p <
0.001, pairwise comparisons Prof-
Sr, Prof-Jr, BFA-1 versus BFA-2, p
< 0.001), time (p = 0.001, pairwise
comparisons year 1 versus year 2 and
year 3, p = 0.004), with an interaction
between time and group (p = 0.001).
Overall tness ratings improved over
time (p < 0.001). While the aerobic
tness of Prof-Sr and Prof-Jr remained
higher than that of the BFA danc-
ers, change over time was seen in
the BFA-2 dancers compared to the
other groups (p < 0.001), improving
consistently over the 3 years.
Twenty dancers from the BFA-2
group were screened consecutively over
Table 3 Mean ± SD for Blood Pressure, Heart Rate, and Fitness Variables
BP HRrest HRpeak HRrecovery Fitness||
Group Gender (mm/Hg)* (beats·min-1)† (beats·min-1)‡ (beats·min-1)§
Prof-Sr Female 103/66 67 ± 9 140 ± 10 82 ± 15 0.60 ± 0.94
Male 113/76 69 ± 11 132 ± 16 85 ± 15 1.22 ± 1.11
Total 107/71 68 ± 10 136 ± 13 83 ± 15 0.89 ± 1.06
Prof-Jr Female 107/67 69 ± 8 141 ± 13 85 ± 13 0.80 ± 0.85
Male 117/76 71 ± 11 132 ± 15 84 ± 12 1.07 ± 0.94
Total 112/72 71 ± 10 136 ± 14 84 ± 12 0.93 ± 0.90
BFA-1 Female 112/70 79 ± 14 153 ± 16 103 ± 20 2.17 ± 1.70
Male 128/74 80 ± 13 145 ± 17 103 ± 19 2.91 ± 1.97
Total 114/71 79 ± 14 152 ± 17 103 ± 20 2.30 ± 1.78
BFA-2 Female 113/69 81 ± 13 162 ± 18 124 ± 23 3.84 ± 1.85
Male 116/70 84 ± 14 141 ± 17 109 ± 21 3.33 ± 1.87
Total 113/69 81 ± 13 160 ± 19 122 ± 23 3.77 ± 1.84
Total Female 111/70 78 ± 14 153 ± 17 104 ± 23 2.26 ± 1.86
Male 123/74 77 ± 13 139 ± 17 95 ± 19 2.20 ± 1.86
All 114/71 77 ± 13 150 ± 18 102 ± 22 2.25 ± 1.86
Abbreviations: blood pressure, BP; heart rate, HR; resting HR, HRrest ; peak HR, HRpeak; 1-min recovery HR, HRrecovery, tness rating, Fitness.
Fitness ratings were determined by HRrecov, gender, and age range and were comprised of 0-7 groupings.23,24 Prof-Sr; junior professional company,
Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2. *Dierences between groups in systolic
BP [F(3,558) = 11.748, p < 0.001]. Post hoc, Prof-Sr and Prof-Jr dancers systolic BP were lower than BFA-1 (p ≤ 0.002); dierences between
genders in systolic BP F(1,558) = 27.208, p < 0.001]. †Dierences between groups in HRrest [F(3,453) = 13.942, p < 0.001]; post hoc Prof-Sr
and Prof-Jr dancers versus BFA-1 and BFA-2 dancers, p < 0.001; BFA versus BFA-2, p < 0.001; there were no dierences between genders in
HRrest. ‡Dierences between groups in HRpeak [F(3,453) = 14.947, p < 0.001]; post hoc Prof-Sr and Prof-Jr dancers versus BFA-1 and BFA-2,
p < 0.001; BFA-1 vs. BFA-2, p = 0.004. dierences between genders in HRpeak [F(3,455) = 25.733, p < 0.001]. §Dierences between groups
in HRrecov [F(3,455) = 30.799, p < 0.001]; post hoc Prof-Sr and Prof-Jr dancers versus BFA-1 and BFA-2, p < 0.001; BFA-1 versus BFA-2, p =
0.004; there were no dierences between genders in HRrecov. ||Dierences between groups in tness categories [F(3,453) = 28.687, p < 0.001];
post hoc Prof-Sr and Prof-Jr versus BFA-1 and BFA-2, p < 0.001; BFA-1 versus BFA-2, p < 0.001; there were no dierences between genders in
tness categories.
16
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
4 years (Table 4). ere were consistent
decreases in HRrecov (p < 0.001, pair-
wise comparisons year 1 versus years 2,
3, and 4, p ≤ 0.021) and improvement
in tness ratings (p = 0.001, pairwise
comparisons year 1 versus years 2, 3,
4, p ≤ 0.006) over the 4 years.
Discussion
Professional dancers exhibited lower
HRrest, HRpeak, HRrecov, and bet-
ter tness ratings compared to pre-
professional dancers. Fitness ratings
did not change from year to year in
professional dancers, but improved
over time in pre-professional dancers.
Correlations of HR variables, tness
ratings, age, BP, and BMI found posi-
tive relationships between HRrecov,
HRpeak, HRrest, and tness ratings,
and a negative relationship between
HRrecov and age, but no relationship
between HRrecov and BMI.
Professional and Pre-Professional
Demographic Characteristics
e dierences between groups in age
and years of dance training but not
in height, mass, or BMI were to be
expected. ere were no dierences
in years of training between the pre-
professional groups, BFA-1, and BFA-
2. erefore, baseline characteristics of
pre-professional dancers did not dier.
Similar rates of smoking and
asthma were reported among groups.
While the rate of smoking found in
the Prof-Sr in this study is higher than
previously reported for this company,21
this project reects data collected from
Prof-Sr from 2006 to 2012. Current
rates in a recent single screening year
Table 4 Mean ±SD Change in Aerobic Fitness
Group # Subjects BP
(mm Hg)* HRrest
(beats min-1)†
HRpeak
(beats·min-1)‡
HRrecovery
(beats·min-1)§ Fitness||
Year 1
Prof-Sr 15 108/73 70 ± 7 133 ± 12 81 ± 13 0.73 ± 0.88
Prof-Jr 6 111/72 67± 4 135 ± 11 74 ± 8 0.33 ± 0.51
BFA-1 13 123/74 83 ± 16 156 ± 12 105 ± 25 3.23 ± 2.27
BFA-2 38 115/69 84 ± 14 164 ± 17 126 ± 23 4.16 ± 1.73
Total 72 115/71 80 ± 14 153 ± 20 108 ± 29 2.96 ± 2.24
Year 2
Prof-Sr 15 101/61 68 ± 8 131 ± 13 79 ± 11 0.67 ± 0.82
Prof-Jr 6 99/52 70 ± 8 149 ± 16 85 ± 15 0.47 ± 0.92
BFA-1 13 108/67 74 ± 8 142 ± 7 89 ± 10 1.23 ± 1.09
BFA-2 38 116/70 80 ± 14 159 ± 18 120 ± 21 3.61 ± 1.67
Total 72 110/67 75 ± 13 149 ± 19 103 ± 25 2.28 ± 1.98
Year 3
Prof-Sr 15 114/77 68 ± 8 131 ± 13 79 ± 11 0.47 ± 0.92
Prof-Jr 6 104/72 68 ± 11 143 ± 13 83 ± 12 0.83 ± 0.98
BFA-1 13 112/71 73 ± 11 144 ± 8 87 ± 11 1.08 ± 1.19
BFA-2 38 111/69 83 ± 15 155 ± 16 114 ± 20 3.24 ± 1.70
Total 72 110/69 77 ± 14 146 ± 17 99 ± 23 2.07 ± 1.89
Year 4
BFA-2 38 116/71 78 ± 14 153 ± 14 109 ± 22 2.09 ± 1.94
Abbreviations: blood pressure, BP; heart rate, HR; resting HR, HRrest; peak HR, HRpeak; 1-min recovery HR, HRrecovery, tness category,
Fitness. Prof-Sr; junior professional company, Prof-Jr; Bachelors of Fine Arts program #1, BFA-1; Bachelors of Fine Arts program #2, BFA-2.
* Dierences in systolic BP between groups [F(3,56) = 6.021, p = 0.001]; post hoc Prof-Sr versus BFA-1, p=0.017, Prof-Sr versus and BFA-2,
p < 0.001; dierences in systolic BP due to time [F(1,56) = 4.261, p = 0.044]; post hoc pairwise comparisons year 1 versus year 2, p = 0.004,
and year 1 versus year 3, p = 0.044; interaction between group and time [F(3,56) = 5.398, p = 0.002]. *Dierences in diastolic BP due to time
[F(1,56) = 8.546, p = 0.005]; post hoc pairwise comparisons year 1 versus year 2, p=0.003; year 2 versud year 3, p = 0.028; no dierences between
groups in diastolic BP. †Dierences in HRrest between groups [F(3,68) = 10.276, p < 0.001]; post hoc pairwise comparisons BFA-2 dancers
versus Prof-Sr and Prof-Jr, p ≤ 0.007; no dierences due to time. ‡Dierences in HRpeak between groups [F(3,60) = 17.839, p < 0.001]; post
hoc pairwise comparisons BFA-2 dancers versus Prof-Sr and Prof-Jr, p ≤ 0.012; no dierences due to time. § Dierences in HRrecov between
groups [F(3,68) = 31.414, p < 0.001]; post hoc pairwise comparisons Prof-Sr, Prof-Jr, BFA-1 v BFA-2, p < 0.001; dierences in HRrecov due
to time [F(1,71) = 5.436, p = 0.023], Interaction between time and group [F(3,68) = 4.472, p = 0.006]. ||Dierences in Fitness between groups
[F(3,68) = 26.773, p < 0.001]; post hoc pairwise comparisons Prof-Sr, Prof-Jr, BFA-1 v BFA-2, p < 0.001; dierences in Fitness due to time
[F(1,68) = 11.259, p=0.001]; post hoc pairwise comparisons year 1 versus year 2 and year 3, p = 0.004; interaction between time and group
[F(3,68) = 5.980, p = 0.001]. Four year analysis of BFA-2: dierences in HRrecov over time [F(1,19) = 23.818, p < 0.001]; post hoc pairwise
comparisons year 1 versus years 2, 3, and 4, p ≤ 0.021; dierences in tness category over time [F(1,19) = 15.035, p = 0.001]; post hoc pairwise
comparisons year 1 versus years 2, 3, 4, p ≤ 0.006.
17
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
are more in line with those previously
reported.21 According to the Center
for Disease Control and Prevention,
19% of adults in the USA report
smoking.26 Although the overall rate
of 9% in this study is lower than the
national average, smoking cessation
support remains an important issue
to promote among all dancers. Studies
report increased fatigue and decreased
VO2 max in smokers compared to
non-smokers.27,28 In 2013 Center
for Disease Control and Prevention
surveillance data, asthma prevalence
was 7% of US adults, 6.2% males
and 8.3% females, 9.9% blacks, 7.4%
whites, and 5.9% Hispanics (N.B.:
the CDC reports ethnicity dierently
than we do here).29 In a recent review,
7 to 8% of Olympic athletes suered
from exercise-induced asthma.30 e
asthma rate of 14% in this study was
higher than both these reports. is
may be explained by several factors,
including the higher prevalence of
asthma in black Americans (almost
half of our population were African
Americans) and the lower asthmatic
stressors induced by dance training
compared to endurance sports. It is
thought that intense training regimens
with the added factors of training
outdoors in the cold, exposure to
particulate matter, exposure to chlora-
mines in the case of swimmers or other
poor quality air, produce a progressive
process of exercise-induced airway
hyper-responsiveness and asthma.30 It
may be that individuals with asthma
are relatively more successful in dance,
which is usually practiced indoors,
compared to endurance sport athletes
who are exposed to these other factors.
Systolic BP differed between
groups and genders but not diastolic
BP, and all BP results were within
normal ranges. While lower BP has
been found to be associated with lower
resting HR and aerobic tness,31 we
did not nd this relationship.
Professional and Pre-Professional
Aerobic Fitness
Aerobic training is an important de-
terminant of maximal oxygen uptake
(VO2 max) as well as related HR vari-
ables.32 Both HRrest and HRrecov are
risk factors for overall mortality.31,33
Therefore, aerobic fitness becomes
important not only as a factor in
fatigue-related injury but for lifelong
health. The fast phase of recovery
following high intensity intermittent
exercise includes a rapid decline in
both VO2 and HR.34 e ability to
recover quickly is critical in dance per-
formance, which may require repeated
episodes of high intensity dancing.
Both professional groups exhib-
ited enhanced aerobic tness, based
on their HRrecov, compared to pre-
professional dancers. Overall, pro-
fessional dancers spent a great deal
more time dancing, whether in class,
rehearsal, or performance, compared
to pre-professional students; and more
Sr-Prof dancers performed cross train-
ing and aerobic training activities in
comparison to the other groups. In a
previous comparison of professional
modern and ballet companies using
the accelerated step test, modern
dancers demonstrated enhanced
aerobic tness compared to their bal-
let counterparts.21 is dierence was
also found in previous studies using
VO2max tests of aerobic fitness in
professional ballet and modern danc-
ers.22,35-40 (N. B.: we did not include
the research reporting on aerobic
fitness in contemporary dancers.
Although modern and contemporary
dance have common roots, it is not
clear whether the current dance train-
ing and performance requirements of
modern and contemporary dancers
are the same.)
Age was negatively correlated to
HRrecov: meaning that older dancers
tended to have improved HRrecov.
is is an unusual nding, as generally
tness declines and HRrecov is slowed
with aging. However, comparisons of
trained younger (in their 20’s) and
older athletes (in their 50’s) found
no dierences in HRrecov.41 e age
range of the dancers in the current
study was a continuum of 18 to 35
years; therefore, the negative relation-
ship between age and HRrecov may
be more reective of the demands of
professional dance.
A review of VO2max in dancers
indicates that female dancers typically
exhibit a range of 39 to 54 and males
45 to 67 ml·kg-1·min-1 values. e
greatest focus to date has been on as-
sessing VO2 max in professional ballet
dancers (females 39 to 53, males 46 to
59 ml·kg-1·min-1).18,35-38,42,43 Less well
studied are modern and other dance
forms in professional or university
level dancers. A summary of VO2
max findings includes professional
modern (females 49 to 52 and males
67 ml·kg-1·min-1),22,39 professional
contemporary (46 ml·kg-1·min-1),44
professional jazz (females 42, males 49
ml·kg-1·min-1),45 professional com-
petitive ballroom (females 42 to 54,
males 53 to 61 ml·kg-1·min-1),46-48
university ballet (females 41 to 47
ml·kg-1·min-1),39,49 and university
modern dancers (females 39 to 51,
combined females and males 51
ml·kg-1·min-1).22,49-51 is summary
suggests that female modern danc-
ers exhibit values similar to those
of professional ballet and ballroom
dancers, and male modern dancers
exhibit higher values than their ballet
and ballroom counterparts.
Comparisons of VO2max in profes-
sional and pre-professional modern
dancers found no dierences in one
study.52 However, in a second study,
increased VO2max suggested higher
aerobic tness in female professional
modern dancers compared to pre-
professional students.39 While this
study did not investigate VO2max, our
ndings of enhanced aerobic tness
(based on HRrecov and tness ratings)
in the professional compared to pre-
professional dancers support the nd-
ings of Chlemar and coworkers.39 We
also found dierences in HRrecov and
tness ratings between pre-profession-
al groups. BFA-1 dancers had greater
aerobic tness compared to BFA-2
dancers. Demographic characteristics
were similar between the two groups.
While we are unable to identify the
reason for this dierence, one program
is considered to be more demanding,
with a dicult audition process for
entry, than the other. It may be that
students entered BFA-1 with a higher
pre-existing baseline of tness and
skill-based training. By the second
year of screening, all pre-professional
students were undergoing relatively
similar dance training; however, in
addition, BFA-2 had weekly supple-
18
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
mental wellness classes. is may ac-
count for some of the improvement
in tness measures seen in BFA-2 over
subsequent years.
e aerobic capacity of dancers is
generally lower than other athletes and
similar to active age-matched individ-
uals.49 While dance performance has
been categorized as a high intensity
intermittent exercise activity,53,54 the
cardiorespiratory response to modern
dance and ballet technique classes is
considered insucient to promote
the aerobic adaptation sought in
higher levels of aerobic tness.54,55
Monitoring of dance class, rehearsal,
and performance in both professional
and pre-professional contemporary
dancers found performance required
signicantly greater HR and oxygen
consumption,54 pointing to a need
for supplemental training. Our results
suggest there is a need for supplemen-
tal training in modern dancers as well.
Changes Over Time in Aerobic
Fitness
All the groups we tested had access to
aerobic and tness equipment. When
results of the screen were reviewed
with each participant, the importance
of supplemental training was always
emphasized. In particular, dancers
were counseled to add supplemental
aerobic training if their tness ratings
were from 3 to 7.
We analyzed change in tness vari-
ables over time in a subset of groups
that underwent annual screening.
e professionals’ HRrecov and t-
ness remained stable over time. Only
one group, BFA-2, demonstrated
improvements in HRrecov and tness.
ere are several explanations for this
nding. First, both groups of profes-
sional dancers spend more hours per
week dancing than both groups of
pre-professional dancers. Second,
based on their annual rehearsal and
performance schedule, it is likely that
Prof-Sr maintained a relatively steady
state of tness. Annually, there is only
one long vacation break of 3 weeks
following a rigorous New York season.
All other breaks are 1 to 2 weeks in
length. e Prof-Jr group had more
time o, but the amount of danc-
ing in which they participated may
have been more rigorous, as there are
only 12 dancers who perform in the
majority of the repertory. In contrast,
the pre-professional dancers were not
in school all summer (approximately
16 weeks), and it is up to them to
take technique classes and maintain
their tness. ird, it is possible that
there was insucient opportunity for
pre-professionals to add supplemen-
tal training to their already rigorous
dance and academic class schedule
during the school year. However, the
mandatory wellness class (50 min/wk)
supplemented BFA-2 training. is
may have played an important part
in the tness improvements measured
over 4 years in the BFA-2 group. e
weekly wellness classes emphasized
the practice of sound dance biome-
chanics and developed individualized
strengthening, stretching, and aerobic
programs for each dancer to perform
on their own. In contrast, BFA-1
dancers learned about injury preven-
tion, including the practice of sound
dance biomechanics and principles
of eective aerobic conditioning, in a
single workshop.
HRrecov improves with aerobic
training and is therefore considered
to be a sensitive marker of change
in aerobic tness over time.56 Pre-
professional dancers demonstrated
improvement in aerobic tness over
time. Professionals, while continuing
to demonstrate greater tness, did
not change. Despite dancing fewer
hours/wk compared to BFA-1, only
the BFA-2 dancers demonstrated
signicant improvement compared
to the other groups. erefore, it is
likely that the mandatory wellness
classes were responsible for this dier-
ence. Researchers have demonstrated
improvement in aerobic tness with
supplemental training of varying
lengths from 6 weeks to 1 year in pre-
professional and professional modern
and contemporary dancers17,50,57 as
well as professional ballet dancers,58,59
thus supporting our ndings. In con-
trast, other researchers have reported
no change in aerobic tness in pre-
professional dancers with a 4-month
conditioning program.60 We may have
seen no change over time in the pro-
fessional dancers as they were main-
taining the aerobic tness required for
their workload, a level that exceeded
that of the pre-professionals.
Preliminary investigations report
that pre-professional ballet dancers
with lower levels of aerobic tness
suer more musculoskeletal injuries
than those with higher levels.14 Several
other studies analyzed injury factors
retrospectively from dance injury
reports and found fatigue to be the
most common variable cited by danc-
ers.12-14 Prospective studies of military
trainees found that lower aerobic
fitness is related to increased risk
for musculoskeletal injury.61 Greater
cardiorespiratory tness might serve
to reduce the eects of fatigue; how-
ever, a clear relationship remains to be
demonstrated for dance.
Supplemental Training
Recommendations for
Pre-Professional Dancers
It is now well established that dance
technique classes by themselves do
not suciently challenge the aerobic
and anaerobic systems to attain the
fitness level necessary for perfor-
mance.44,53,54,62 Studies suggest that
dance performance requires energy
expenditure up to 85% of VO2 max
and 80-95% of HRmax.37,63,64 Increas-
ingly, recommendations are being
made for dancers to supplement their
dance training with aerobic condi-
tioning.20,53,65 Research suggests that
a combination of high volume low to
moderate intensity (HVL-MI) aerobic
exercise combined with short-term
high intensity interval training (HIIT)
may provide optimal training.66,67
Aerobic exercise includes running,
swimming, cycling, aerobics classes,
or other continuous activities that
result in an increased HR for 20 to 40
minutes. An optimal target training
range is 70 to 90% of HRmax (HRmax
is estimated as 220-age).20,53 To make
improvements, exercise frequency of 3
to 4 times/wk is recommended. When
considering supplemental training to
increase performance, the majority of
focus is on (HVL-MI) aerobic exer-
cise. is provides the platform upon
which to introduce HIIT exercise.
Maintenance programs, when HIIT
activities are introduced or dancers
19
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
have begun performance, require
HVL-MI training 1 to 2 times per
week.
HIIT involves intermittent exer-
cise at “all-out” or “supra-maximal”
intensity,66 in which participants work
at levels greater than or equal to 90%
to 95% VO2 max or 90% to 95%
HRmax.67 e type of exercise may in-
clude bursts of sprint running, sprint
cycling, jumping, or combinations
thereof. HIIT exercise is comprised of
anywhere from 1:1 to 1:5 ratios of ex-
ercise to active rest (active rest such as
walking or slow jogging is encourage
to promote faster recovery) depending
on the age of the population, level of
training, and type of training. A range
of intervals have been suggested, for
example, from 15 seconds of exercise
and 15 seconds of active rest (1:1
ratio) to 30 seconds of exercise and 2
minutes of active rest (1:4 ratio).66-69
ese bouts of alternating exercise
followed by active rest are repeated up
to 10 times. Generally, based on the
research literature, a limited period
of HIIT exercise is recommended 2
to 4 weeks before the dancer wishes
to reach peak performance levels. A
ratio of 75% HVL-MI aerobic train-
ing to 10 to 15% HIIT activity is
recommended (with less than 10%
devoted to warm up and cool down
low intensity activity). Too much
HIIT exercise, particularly without
adequate recovery, can lead to over-
training and burnout.66,70
Dance performance is comprised
of intermittent periods of varying
lengths that range from low to high
intensity, with some choreography
comprised of greater periods of high
intensity while others may fluctu-
ate between various levels. Intense
exercise performance requires both
aerobic and anaerobic components.
Both types of training, as outlined
above, are important because dierent
adaptations occur depending on the
type of training.
Limitations
Our annual screening does not assess
VO2max due to the number of dancers
that are screened in a relatively short
time and equipment constraints. Al-
though our results report preseason
aerobic tness in dancers, it should
be noted that this estimate is relative
to physical tness criteria and does
not indicate the participant’s level of
skill-related tness.
Heart rate has a positive relation-
ship to energy expenditure during
physical activity and can serve as an
accurate indirect measure to evalu-
ate metabolic demand.71 e 1-min
HRrecov variable represents the fast
recovery phase, with more rapid
recovery indicating individuals with
a higher aerobic capacity.41 VO2max
is not required to estimate aerobic
tness, as HRrecov has demonstrated
a strong relationship with training
in steady state, moderate, and high
intensity exercise, as well as intermit-
tent exercise.34,71-73
Recent research has focused on al-
ternative ways of screening for aerobic
tness in dancers, such as the Dance
Specic Aerobic Fitness Test (DAFT)
for contemporary dancers and a ballet-
specific test.44,74-76 One argument
against using dance-specic tness
tests is that a given test may only
be appropriate for one dance form
(e.g., contemporary dance or ballet),
require a familiarization period, and
can be lengthy (up to 20 min).44,76
While these tests measure maximal
HR, they do not report HRrecov and
therefore cannot be compared with
the results of the accelerated step test.
Furthermore, they do not allow for
comparisons across genres.
Currently, the Dance/USA post-
hire health screen, used to evaluate
the professional modern dancers in
this study, provides only 20 min per
dancer for the assessment of medical
history, vital signs, tness, and other
physiologic measures.1,77 ese tests
are administered onsite in the dance
studio or physical therapy room. e
accelerated step test, requiring a total
of 4-min, is ecient and utilizes mini-
mal, low cost equipment.
As greater numbers of dancers at
all levels of training are screened, we
will be able to establish norms for
various parameters. In the future, this
will enable researchers, dance faculty,
healthcare providers, and company
artistic sta to establish best practice
to optimize training and conditioning
for dancers of all ages.
Conclusion
e ability to conduct large studies
on dancers is limited. Here, we report
screening results from the largest
group of professional and pre-profes-
sional modern dancers tested to date
in the USA. Screening programs will
not by themselves decrease injuries; it
is through the information gathered
from screening that change may be
studied and implemented. Dierences
between pre-professional and profes-
sional dancer aerobic tness suggest
it remains particularly important to
emphasize aerobic training at the pre-
professional level as preparation for
the demands of professional careers.
If we classify dance as having compo-
nents of high-intensity intermittent
exercise, aerobic fitness enhances
recovery from these recurrent periods.
e ability to recover quickly is criti-
cal to enable optimal performance in
subsequent choreographic sequences.
Greater aerobic conditioning during
pre-professional training is impera-
tive to meet the increasing demands
of choreography at the professional
level. Future study of the relationship
between aerobic tness and imple-
mentation of more stringent training
programs on the incidence of injury
is necessary.
Practical Implications
• Professional modern dancers dis-
play greater aerobic tness than
pre-professional dancers.
• Supplemental aerobic training is
recommended for pre-professional
modern dance students to prepare
themselves for the demands of a
professional career.
• Wellness programs that include
aerobic exercise appear to be eec-
tive in improving aerobic tness in
pre-professional dancers.
References
1. Southwick H, Gibbs R, Bronner
S, Cassella M. Update on the an-
nual post-hire health screen for
professional dancers: Dance/USA
Taskforce on Dancer Health. Pre-
sented at: XVIII Annual Meeting
of International Association for
20
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
Dance Medicine & Science 2008.
Cleveland, OH: IADMS, 2008.
2. Klossner D. National Collegiate
Athletic Association. 2013-14
NCAA Sports Medicine Handbook
(24th ed). Indianapolis, IN: Nation-
al Collegiate Athletic Association,
2013. Available at: www.ncaa.org/
sites/default/les/2013-14 Sports
Medicine Handbook.pdf.
3. Fuller M, Peirce D. Screening
practices in dance: applying the
research. Presented at: Dance
Dialogues: Conversations across
Cultures, Artforms and Practices.
Brisbane, Australia, 2008.
4. Gamboa JM, Roberts LA, Maring
J, Fergus A. Injury patterns in elite
preprofessional ballet dancers and
the utility of screening programs
to identify risk characteristics. J
Orthop Sports Phys Ther. 2008
Mar;38(3):126-36.
5. Molnar M, Esterson J. Screen-
ing students in a pre-professional
ballet school. J Dance Med Sci.
1997;1:118-21.
6. Southwick H, Cassella M. Boston
ballet student screening clinic: an
aid to injury prevention. Orthop
Phys Ther Practice. 2002;14:14-6.
7. Department of Performing Arts
LIUB. Dance Wellness. Available
at: www.liu.edu/Brooklyn/Aca-
demics/Schools/CLAS/Programs/
Div4/PA/Dance2/Dance-Wellness.
Accessed September 14, 2014,
2014.
8. Department of Dance Case Western
Reserve. Dancer Wellness Program.
dance.case.edu/dancer-wellness-
program/. Accessed February 23,
2015.
9. Texas A&M Dance Program.
Dancer Wellness Clinic. dance.
tamu.edu/about/dance-wellness.
Accessed Febrary 23, 2015.
10. Clark T, Gupta A, Ho CH. Develop-
ing a dancer wellness program em-
ploying developmental evaluation.
Front Psychol. 2014 Jul 10;5:731.
11. Deprati E, Iosa M, Haggard P. A
dance to the music of time: aes-
thetically-relevant changes in body
posture in performing art. PlosOne.
2009;4(3):e5023.
12. Laws H. Fit to Dance 2—Report of
the Second National Inquiry Into
Dancers’ Health and Injury in the
UK. London, UK: Dance UK, 2005.
13. Liederbach M, Compagno J. Physi-
ological aspects of fatigue-related
injuries in dancers. J Dance Med
Sci. 2001;5:116-20.
14. Twitchett E, Brodrick A, Nevill
AM, et al. Does physical tness
aect injury occurrence and time
loss due to injury in elite vocational
ballet students? J Dance Med Sci.
2010;14(1):26-31.
15. Angioi M, Metsios GS, Koutedakis
Y, et al. Physical tness and sever-
ity of injuries in contemporary
dance. Med Probl Perform Art.
2009;24:26-9.
16. Angioi M, Metsios GS, Koutedakis
Y, Wyon MA. Fitness in contempo-
rary dance: a systematic review. Int
J Sports Med. 2009 Jul;30(7):475-
84.
17. Angioi M, Metsios GS, Twitchett
EA, et al. Eects of supplemental
training on fitness and aesthetic
competence parameters in contem-
porary dance. Med Probl Perform
Art. 2012 Mar;27(1):3-8.
18. Brinson P, Dick F. Fit to Dance?
London: Calouse Gulbenkian
Foundation, 1996.
19. Redding E, Wyon M, Shearman J,
Doggart L. Validity of using heart
rate as a predictor of oxygen con-
sumption in dance. J Dance Med
Sci. 2004;8:69-72.
20. Wyon MA. Cardiorespiratory train-
ing for dancers. J Dance Med Sci.
2005;9:7-12.
21. Bronner S, Ojofeitimi S, Bailey
Lora J, et al. A preseason cardio-
respiratory profile of dancers in
nine professional ballet and mod-
ern companies. J Dance Med Sci.
2014;18:72-81.
22. Bronner S, Rakov S. An accelerated
step test to assess dancer preseason
aerobic tness. J Dance Med Sci.
2014;18:12-21.
23. American College of Sports Medi-
cine. ACSM’s Guidelines for Ex-
ercise Testing and Prescription
(8th ed). Philadelphia: Lippincott
Williams & Wilkins, 2009.
24. Golding L, Myers C, Sinning WE.
The YMCA Physical Fitness Test
Battery. Y’s Way to Physical Fitness
(4th ed). Champaign, IL: Human
Kinetics, 1989, pp. 61-138.
25. Gibbs R, Bronner S, Cassella M, et
al. Annual Post-Hire Health Screen
for Professional Dancers Guide-
lines. 2006. Available at: Available
at: www2.danceusa.org/uploads/
Dancer_Health/resources_Health-
ScreenGuidelines.pdf.
26. Schiller JS, Lucas JW, Peregory JA.
Summary Health Statistics for U.S.
Adults: National Health Interview
Survey. Washington, DC: PUB-
LISHER NAME, 2012.
27. Klausen K, Andersen C, Nandrup S.
Acute eects of cigarette smoking
and inhalation of carbon monox-
ide during maximal exercise. Eur
J Appl Physiol Occup Physiol.
1983;51(3):371-9.
28. Lee C-L, Chang W-D. The eects
of cigarette smoking on aerobic and
anaerobic capacity and heart rate
variability among female university
students. Int J Womens Health.
2013;5:667-79.
29. Asthma surveillance data. US Dept.
of Health and Human Services;
2013. Available at: www.cdc.gov/
asthma/asthmadata.htm. Accessed
February 26, 2015.
30. Kippelen P, Fitch KD, Anderson
SD, et al. Respiratory health of elite
athletes - preventing airway injury:
a critical review. Br J Sports Med.
2012 Jun;46(7):471-6.
31. Tell GS, Vellar OD. Physical tness,
physical activity, and cardiovascu-
lar disease risk factors in adoles-
cents: The Oslo younth study. Prev
Med. 1988 Jan;17:12-24.
32. Uth N, Sorensen H, Overgaard K,
Pedersen PK. Estimation of VO2max
from the ratio between HRmax
and HRrest—the Heart Rate Ratio
Method. Eur J Appl Physiol. 2004
Jan;91(1):111-15.
33. Watanabe J, amilarasan M, Black-
stone EH, et al. Heart rate recovery
immediately after treadmill exer-
cise and left ventricular systolic
dysfunction as predictors of mor-
tality: the case of stress echocar-
diography. Circulation. 2001 Oct
16;104(16):1911-16.
34. Tomlin DL, Wenger HA. e re-
lationship between aerobic tness
and recovery from high intensity
intermittent exercise. Sports Med.
2001;31(1):1-11.
35. Cohen JL, Segal KR, Witriol I,
McArdle WD. Cardiorespiratory
responses to ballet exercise and the
VO2max of elite ballet dancers. Med
Sci Sports Exerc. 1982;14(3):212-17.
36. Micheli LJ, Gillespie WJ, Walaszek
A. Physiologic profiles of female
professional ballerinas. Clin Sports
Med. 1984 Jan;3(1):199-209.
37. Schantz P, Astrand P. Physiolog-
ic characteristics of classical bal-
Author:
Ref 26 is incomplete. Please provide name of publisher.
21
Journal of Dance Medicine & Science • Volume 20, Number 1, 2016
let. Med Sci Sports Exerc. 1984
Oct;16(5):472-6.
38. Wyon MA, Deighan MA, Nevill AM,
et al. e cardiorespiratory, anthro-
pometric, and performance charac-
teristics of an international/national
touring ballet company. J Strength
Cond Res. 2007 May;21(2):389-93.
39. Chmelar RD, Schultz BB, Ruhling
RO, et al. A physiologic profile
comparing levels and styles of fe-
male dancers. Phys Sportsmed.
1988;16:87-94.
40. Kirkendall DT, Calabrese LH. Physi-
ological aspects of dance. Clin Sports
Med. 1983 Nov;2(3):525-37.
41. Darr KC, Bassett DR, Morgan BJ,
omas DP. Eects of age and train-
ing status on heart rate recovery after
peak exercise. Am J Physiol. 1988
Feb;254(2 Pt 2):H340-3.
42. Mostardi RA, Portereld JA, Green-
berg B, et al. Musculoskeletal and
cardiopulmonary characteristics of
the professional ballet dancer. Phys
Sportsmed. 1983;11:53-61.
43. Rimmer JH, Jay D, Plowman
SA. Physiological characteristics of
trained dancers and intensity level
of ballet class and rehearsal. Impulse.
1994;2:97-105.
44. Redding E, Weller P, Ehrenberg S, et
al. e development of a high inten-
sity dance performance tness test. J
Dance Med Sci. 2009;13(1):3-9.
45. Lavoie JM, Lebe-Neron RM. Physi-
ological eects of training in profes-
sional and recreational jazz dancers.
J Sports Med Phys Fitness. 1982
Jun;22(2):231-6.
46. Kline GM, Porcari JP, Hintermeister
R, et al. Estimation of VO2max from
a one-mile track walk, gender, age,
and body weight. Med Sci Sports
Exerc. 1987 Jun;19(3):253-9.
47. Bria S, Bianco M, Galvani C, et al.
Physiological characteristics of elite
sport-dancers. J Sports Med Phys
Fitness. 2011 Jun;51(2):194-203.
48. Liiv H, Jürimäe T, Mäestu J, et al.
Physiological characteristics of elite
dancers of dierent dance styles. Eur
J Sport Sci. 2014;14 Suppl 1:S429-
36.
49. White SB, Philpot A, Green A, Bem-
ben MG. Physiological comparison
between female university ballet and
modern dance students. J Dance
Med Sci 2004;8:5-10.
50. Koutedakis Y, Hukam H, Metsios
G, et al. e eects of three months
of aerobic and strength training on
selected performance- and tness-
related parameters in modern dance
students. J Strength Cond Res. 2007
Aug;21(3):808-12.
51. Wyon M, Head A, Sharp C, Redding
E. e cardiorespiratory responses
to modern dance classes: dierences
between university, graduate, and
professional classes. J Dance Med
Sci. 2002;6(2):41-5.
52. Chateld SJ, Byrnes WC, Lally DA,
Rowe SE. Cross-sectional physiologic
proling of modern dancers. Dance
Res J. 1990;22:13-20.
53. Raerty S. Considerations for inte-
grating tness into dance training. J
Dance Med Sci. 2010;14:45-9.
54. Wyon MA, Abt G, Redding E, et
al. Oxygen uptake during modern
dance class, rehearsal, and perfor-
mance. J Strength Cond Res. 2004
Aug;18(3):646-9.
55. Cohen JL, Segal KR, Witriol I,
McArdle WD. Cardiorespiratory
responses to ballet exercise and the
VO2max of elite ballet dancers. Med
Sci Sports Exerc. 1982;14(3):212-17.
56. Lamberts RP, Swart J, Noakes TD,
Lambert MI. Changes in heart rate
recovery after high-intensity training
in well-trained cyclists. Eur J Appl
Physiol. 2009 Mar;105(5):705-13.
57. Redding E, Irvine S, Quin E,
Raerty S. Dance science: scien-
tic investigations into the eect of
dance specic tness training and
its impact upon pedagogic practices
and dance performance. Presented
at: International Symposium on
Performance Science. Auckland,
New Zealand, 2009.
58. Smol E, Fredyk A. Supplemen-
tary low-intensity aerobic training
improves aerobic capacity and
does not aect psychomotor per-
formance in professional female
ballet dancers. J Hum Kinet. 2012
Mar;31:79-87.
59. Ramel E, Thorsson O, Wollmer P.
Fitness training and its eect on
musculoskeletal pain in profes-
sional ballet dancers. Scand J Med
Sci Sports. 1997 Oct;7(5):293-8.
60. Roussel NA, Vissers D, Kuppens K,
et al. Eect of a physical condition-
ing versus health promotion inter-
vention in dancers: a randomized
controlled trial. Man Ther. 2014
Dec;19(6):562-8.
61. Lisman P, O’Connor FG, Deuster
PA, Knapik JJ. Functional move-
ment screen and aerobic fitness
predict injuries in military train-
ing. Med Sci Sports Exerc. 2013
Apr;45(4):636-43.
62. Wyon MA, Head A, Sharp NC,
Redding E. The cardiorespiratory
responses to modern dance classes:
differences between university,
graduate, and professional classes.
J Dance Med Sci. 2002;6:41-5.
63. Cohen JL, Segal KR, McArdle WD.
Heart rate response to ballet stage
performance. Phys Sportsmed.
1982;10:120-33.
64. Twitchett EA, Koutedakis Y, Wyon
MA. Physiological fitness and
professional classical ballet perfor-
mance: a brief review. J Strength
Cond Res. 2009 Dec;23(9):2732-
40.
65. Irvine S, Redding E, Raerty S.
Dance tness. IADMS Resource
Paper. Available at: c.ymcdn.com/
sites/www.iadms.org/resource/
resmgr/resource_papers/dance_t-
ness.pdf. Accessed February 23,
2015.
66. Laursen PB. Training for intense
exercise performance: high-intensi-
ty or high-volume training? Scand J
Med Sci Sports. 2010 Oct;20 Suppl
2:1-10.
67. Wislo U, Ellingsen O, Kemi OJ.
High-intensity interval training to
maximize cardiac benets of exer-
cise training? Exerc Sport Sci Rev.
2009 Jul;37(3):139-46.
68. Billat LV. Interval training for per-
formance: a scientic and empirical
practice. Special recommendations
for middle- and long-distance run-
ning. Part II: anaerobic interval train-
ing. Sports Med. 2001 Feb;31(2):75-
90.
69. Tabata I, Nishimura K, Kouzaki M,
et al. Eects of moderate-intensity
endurance and high-intensity inter-
mittent training on anaerobic capac-
ity and VO2max. Med Sci Sports
Exerc. 1996 Oct;28(10):1327-30.
70. Billat VL, Flechet B, Petit B, et al.
Interval training at VO2max: eects
on aerobic performance and over-
training markers. Med Sci Sports
Exerc. 1999 Jan;31(1):156-63.
71. Strath SJ, Swartz AM, Bassett DR
Jr, et al. Evaluation of heart rate
as a method for assessing moder-
ate intensity physical activity. Med
Sci Sports Exerc. 2000 Sep;32(9
Suppl):S465-70.
72. Bernard T, Gavarry O, Bermon S,
et al. Relationships between oxygen
Author:
Ref 26 is incomplete. Please provide name of publisher.
22
Volume 20, Number 1, 2016 • Journal of Dance Medicine & Science
consumption and heart rate in transi-
tory and steady states of exercise and
during recovery: inuence of type of
exercise. Eur J Appl Physiol Occup
Physiol. 1997;75(2):170-6.
73. Short KR, Sedlock DA. Excess
postexercise oxygen consumption
and recovery rate in trained and
untrained subjects. J Appl Physiol
(1985). 1997 Jul;83(1):153-9.
74. Olson MS, Williford HN, Blessing
DL, et al. A test to estimate VO2max
in females using aerobic dance, heart
rate, BMI, and age. J Sports Med
Phys Fitness. 1995 Sep;35(3):159-
68.
75. Wyon M, Redding E, Abt G, et al.
Development, reliability, and validity
of a multistage dance specic aerobic
tness test (DAFT). J Dance Med
Sci. 2003;7:80-4.
76. Twitchett E, Nevill A, Angioi M,
et al. Development, validity, and
reliability of a ballet-specic aero-
bic tness test. J Dance Med Sci.
2011;15:123-7.
77. Kadel N, Southwick H, Cole HH.
Update on the annual post-hire
health screen for professional danc-
ers: Dance/USA Taskforce on Dancer
Health. Annual Dance USA Con-
ference. Chicago, IL: Dance/USA,
2011.
